Optimizing your artificial pancreas: Omnipod 5

Artificial pancreas systems, or hybrid closed loop systems, are designed to take over some of the work involved in managing type 1 diabetes (T1D). They can automatically adjust part of the insulin delivery based on data received from a continuous glucose monitoring (CGM) sensor and a mathematical algorithm.

However, this does not mean that everything becomes automatic. It is still important to learn how to use your system, understand its various settings, and, depending on the situation, continue to make adjustments for meals, physical activity, or certain specific situations.

The various artificial pancreas systems available in Canada have different features and ways of functioning. Understanding what your system can do and how to use it can therefore help you get the most out of it.

In the BETTER registry, which collects information about the experiences of people living with T1D in Canada, nearly 90% of participants currently use a continuous glucose monitor. This technology makes it possible to track blood glucose levels throughout the day and night and to see how much time glucose levels spend within a certain range. This measure, called time in range, corresponds to the percentage of time spent between 3.9 and 10.0 mmol/L. It complements the information provided by glycated hemoglobin (HbA1c). HbA1c provides an indication of average blood glucose levels over the past few months, while time in range offers a more concrete picture of what’s happening from day to day.

What can help improve time in range with Omnipod 5?

A recent study looked at how 176,405 people living with T1D and using Omnipod 5 managed their blood glucose in real-world settings in the United States and Europe. The researchers analyzed their data over a three-month period to see which settings and ways of using the system were associated with better time in range.

In total, 34.8% of people spent more than 70% of their time within the target range. The researchers then compared those who met this goal with those who did not, to see what might set them apart, particularly in how they used Omnipod 5 and the settings they chose.

Which settings were associated with better results?

People who spent more time within the target range tended to:

• spend at least 90% of the time in Automatic mode;
• administer at least 3 boluses per day;
• use a blood glucose target of 6.1 mmol/L;
• use more intensive insulin-to-carbohydrate ratio and correction factor settings.

But what do these settings mean?

The insulin-to-carbohydrate ratio determines the amount of insulin needed to cover the carbohydrates in a meal. For example, with a ratio of 1:10, one unit of insulin covers approximately 10 g of carbohydrates.

The correction factor, also known as the insulin sensitivity factor, indicates how much a unit of insulin should lower blood glucose.

With Omnipod 5, these two settings play an important role in the amount of insulin delivered at meals and when blood glucose is high. Compared with some other hybrid closed loop systems, Omnipod 5 may require more intensive insulin-to-carbohydrate ratio and correction factor settings to allow the system to deliver more insulin in these situations.

The insulin-to-carbohydrate ratio and correction factor are both calculated using the total daily insulin dose (TDD). In this study, among people with better time in range, the insulin-to-carbohydrate ratio was calculated as 350 ÷ TDD, while the correction factor was calculated as 83 ÷ TDD.